Dissociative Identity Disorder: Treatment and Management

✍ Scribed by Hassaan Tohid (editor), Ian Hunter Rutkofsky (editor)

• Publisher: Springer
• Year: 2023
• Tongue: English
• Leaves: 293
• Category: Library

✦ Synopsis

This book contains new evidence and more ideas for treatment and management of dissociative identity disorder (DID). It is written from the standpoint of an expert in the field for other professionals that deal with or are interested in DID.

Chapters are divided into 4 parts. Part 1 acts as an introduction to understanding dissociative identity disorder, such its history, the different types of the disorder, and its portrayal in popular culture. The chapters in this part cover multiple personality disorder, theories, and epidemiology of the disease. Part 2 discusses the pathology and neuroscience of the disease. The comorbidities related to the disorder will be explained, such as PTSD, depression, anxiety, schizophrenia, and more. This part concludes with the potential causes of dissociative identity disorder, which ties into the previously mentioned comorbidities throughout this part. Supplementing the aforementioned topics, Part 3 discusses management of the disease. The chapters will cover modern psychiatry, diagnosis, and treatment options. Drug treatment and psychotherapy are some examples of the treatment options available. The authors share their experiences and perspectives of managing DID, including clinical trials and recovery. Finally, Part 4 discusses the sociology of DID, such as potential drug abuse, social media presence, and the difficulties that psychiatrists face in diagnosing the disease. This part provides advice for clinicians and healthcare providers by sharing different perspectives from psychiatrists that encounter the disease.

Written by experts in the field, Dissociative Identity Disorder serves as a valuable resource for psychiatrists and clinicians seeking to understand, treat, and manage the disease.

✦ Table of Contents

Preface
Acknowledgment
Contents
About the Editors
1: History of Dissociative Identity Disorder (DID)
Introduction
History of Dissociative Identity Disorder (DID)
Early History
Twentieth Century
Sybil
DID and Hypnosis
DID in Twenty-First Century
Types of Dissociative Identity Disorder
Impact of Social Media on DID
Prevalence and Diagnosis
Possible Treatment and Management
Conclusion
References
2: Dissociative Identity Disorder and the DSM
Introduction
Discussion
The Evolution of the DSMs
DID and DSM-V: Diagnostic Criteria
The Prevalence, Development, and Course of DID
Diagnostic Issues in the DSM-V and Functional Consequences
Interview with an Expert Psychiatrist
Dr. Allen Frances Questionnaire
Conclusion
References
3: Dissociative Identity Disorder: Theory vs. Facts
Dissociative Identity Disorder (DID)
Myths Regarding Prevalence of the Condition
Myths and Theories Confusing It with Other Psychiatric Disorders
Myths Regarding the Alters
Concepts and Myths Related to Introjects
Myths Regarding Patient’s Behavioral Symptoms
References
4: Different Kinds of Dissociative Disorders, Including Dissociative Identity Disorder
Introduction
Conceptualization of Dissociative Spectrum Disorders
Epidemiology
Etiology: Theories and Models of Dissociation
The Posttraumatic Model (TM)
The Sociocognitive Model (SCM)
Sleep Model (SM)
Dissociation and Memory System
Dissociation and Information Processing
Current Understanding of Dissociative Disorders: Diagnosis and Treatment
Dissociative Identity Disorder
Epidemiology
Differential Diagnosis
Course
Treatment
Adjunctive Treatment
Dissociative Amnesia
Diagnosis and Clinical Features
Differential Diagnosis
Dissociative Fugue (A Subtype of Dissociative Amnesia)
Epidemiology
Differential Diagnosis
Depersonalization/Derealization Disorder
Etiology
Other Specified or Unspecified Dissociative Disorder
Ganser Syndrome
Conclusion
References
5: Ketamine: Should Such a Dissociative Agent Be Used for Anesthesia, Anti-Depression/Suicidality, and Analgesia in DID Patients?
Introduction
Ketamine
History
Ketamine: Indications
Ketamine: Pharmacokinetics, Dosage, and Administration
Ketamine: Mechanism of Action
Ketamine: Mechanism of Action Responsible for Dissociative Properties
Ketamine: Adverse Effects
Ketamine: Dissociation and Other CNS Adverse Effects
Ketamine: Contraindications and Cautions
The Correlation Between Dissociation and the Efficacy of Ketamine
Dissociation and Anti-depression
Use of Ketamine with Dissociative Identity Disorder
Dissociation in DID: Pathophysiology
Current Literature: Use of Ketamine in DID Patients
Controversy: Can Ketamine Be Safely Used in DID Patients?
References
6: Culture and Dissociation
Introduction
Discussion
Conclusion
References
7: Epidemiology of Dissociative Identity Disorder
Introduction
Epidemiology
Incidence and Prevalence
Comorbidities
Risk Factors
Conclusion
References
8: Multiple Personality in Popular Culture
Introduction
Discussion
Language
Literature
Literary Doubles
Comic Books
Television
Conclusion
References
Cultural References to Multiplicity Literature
9: Dissociative Identity Disorder in Hollywood and Other Movies
Introduction
Discussion: Films
Shutter Island
Fight Club
Psycho
Sybil
Split
Monsters Inside: The 24 Faces of Billy Milligan
Conclusion
References
10: An Effective Approach to Treatment of PTSD and Other Dissociative Disorders: One Practitioner’s Experience
Introduction
Modalities
Clinical Interviews and Assessments
Two Case Studies
Case Study 1: Ms. S
Case Study 2: Mr. R
Summary
Conclusion
References
11: DID and Depression
Introduction
Dissociative Depression
Neurophysiology and Neurocircuitry Underlying DID
Differences in Symptomatology and Pathogenesis Between Comorbid Depression in DID and MDD
Diagnostic and Therapeutic Considerations
Conclusion
References
12: Dissociative Identity Disorder and Anxiety
Introduction
Discussion
Anxiety as a Symptom of DID
Treatment of Anxiety in DID Patients
Conclusion
References
13: Dissociative Identity Disorder and Trauma
Introduction
Dissociation Versus Dissociative Disorders
ICD-10 Criteria
ICD-11
Epidemiology of Dissociative Disorders
Neurophysiology
Etiology of Dissociative Disorders and Trauma
Additional Consideration
Evaluating Patients
The Dissociative Subtype of PTSD
Impacts of Trauma and Dissociation
Treatment of Dissociative Disorders
Permissions
References
14: Dissociative Identity Disorder and Other Specified Dissociative Disorder (OSDD)
Introduction
Types of Other Specified Dissociative Disorder
OSDD-I Chronic and Recurrent Syndromes of Mixed Dissociative Symptoms
OSDD-II Identity Disturbance Due to Prolonged and Intense Coercive Persuasion
OSDD-III Acute Dissociative Reactions to Stressful Events
OSDD-IV Dissociative Trance
Changes to Dissociative Disorder in the DSM-5
Changes in the Definition of Dissociation
Changes in Diagnostic Criteria to the Dissociative Disorders
Changes to Dissociative Identity Disorder
Changes to Dissociative Disorders Not Otherwise Specified
Other Specified Dissociative Disorders and Unspecified Dissociative Disorders
Epidemiology/Etiology
Other Specified Dissociative Disorder (OSDD) Type 1: Chronic and Recurrent Syndromes of Mixed Dissociative Symptoms
Treatment of Other Specified Dissociative Disorder Type 1
Other Specified Dissociative Disorder (OSDD) Type 2: Coercive Persuasion
Definition
Diagnosis and Clinical Features
Treatment
Other Specified Dissociative Disorder (OSDD) Type 3: Acute Dissociative Reactions to Stressful Events
Definition
Diagnosis and Clinical Features
Nonpsychotic Cases
Treatment
Other Specified Dissociative Disorder (OSSD) Type 4: Trance Disorder
Definition
Clinical Presentation
Cultural Syndromes
Treatment
References
15: Dissociative Identity Disorder and Schizophrenia
Introduction
DID Vs Schizophrenia
DSM-5 Criteria Vs Schizophrenia Vs DID
Auditory Hallucinations
Epidemiology DID and Schizophrenia
Etiology/Risk Factors in DID Vs Schizophrenia
Pathophysiology for DID Vs Schizophrenia
Biological Factors
Environmental Factors, Nutrition Status, and Maternal Infections
Network Structure Theory Vs Dimensional Model
Trauma History
Prognosis for DID Rather than SCZ
Clinical Case Presentation for DID or Schizophrenia
Diagnosis
Clinical Interview
Differential Diagnosis
Treatment Options
Pharmacological and Psychotherapy
Conclusion
References
16: Child and Adolescent DID
Introduction
Theory of Dissociated Identity Disorder
Clinical Presentation of DID
Diagnosis
Differential Diagnoses
Management
Commentary
References
17: DID in Male Patients
Introduction
Epidemiology
Risk Factors for DID in Men
Locations of Presentation
Symptomatology at Presentation
Diagnosis of DID in Men
Treatment of DID in Men
Men in the Sociocognitive Model
Men in the Trauma Model
Conclusion
References
18: DID in Borderline Personality Disorder
Introduction
Epidemiology
Etiology/Risk Factors
Prognosis
Clinical Presentations
Diagnosis
Clinical Interview
Differentials
Treatment Options
Conclusion
References
19: Dissociative Identity Disorder and Bipolar Disorder
Introduction
DID Vs Bipolar
Epidemiology
Etiology/Risk Factors
Prognosis
Clinical Presentations
Diagnosis
Differentials
Treatment Options
Conclusion
References
20: Understanding Dissociative Identity Disorder
Introduction
Criteria
Predisposing Factors and Causes
Daily System and Defensive System
Trauma and the Interruption of Open Communication Between the Two Action Systems
The Relationship of Daily System and the Defensive System
The Daily Living System’s Avoidance Response
The Defensive System’s Fixation Response
Structural Dissociation
Primary, Secondary, and Tertiary Structural Dissociation
Primary Structural Dissociation
Secondary Structural Dissociation
The Process of Secondary Structural Dissociation
Tertiary Structural Dissociation and Dissociative Identity Disorder
Psychobiology of DID
History of DID
References
21: Dissociation in Animals
Introduction
Freeze Response in Animals
Biological Aspects of Dissociation in the Mammalian Brain
The Phenomena of Trauma and Distress in Animals
Conclusion
References
22: Genetics and Dissociative Identity Disorder (DID)
Conclusion
References
23: Dissociative Identity Disorder and the Human Brain; Neuroanatomy
Introduction
Discussion
Neuroimaging
Cortico-Limbic Disconnect Model
Brain Networks
Glutamate’s Role in Neurotransmission
Conclusion
References
24: Pathophysiology of Dissociative Identity Disorder
Big Picture: Dissociation → Conversion
Impairment of Daily Living
What Causes DID?
Proposed Etiology of Dissociative Identity Disorder
Current Focus in Research
Areas of Impact
fMRI
PET Scan
SPECT
Affected Functions in D.I.D.
Memory
Identity
Consciousness
Perception
Conclusion
References
25: Risk Factors of Dissociative Identity Disorder
References
26: Causes of Dissociative Identity Disorder
Introduction
Relevant Models and Theories
Trauma Model
Fantasy Model
Relation to Other Pathology
Early Markers for Predicting DID Development
Role of Trauma in DID Development
Interpersonal Stressors
Environmental Stressors
Impact of Childhood Trauma
Schneiderian Symptoms in Trauma Model
Sociocognitive or Non-Trauma-Related Model
Causes Related to High Fantasy Proneness
Enactment
Sleep Disturbances
Suggestive Psychotherapy
Sociocultural Influences
Similarities between the Trauma and Fantasy Model
Neurobiologic Correlation in DID Development
Hippocampal Volume and Changes in Brain Morphology
Brain Activation Studies
Conclusion
References
27: DID and Diagnosis
Intro/Diagnostic Criteria
History of DID Diagnosis
Diagnostic Tools
Clinician-Administered Tools
Self-Report Tools
Challenges in Diagnosis
Future Directions in Diagnosis
Conclusion
References
28: DID and Differential Diagnoses
Introduction
DID and Other Dissociative Disorders
General Comments on Dissociation in Non-dissociative Psychiatric Disorders; Etiology with Trauma
DID and Personality Disorders
DID and Mood Disorders
DID and Psychotic Disorders
Pseudoneurological Symptoms, Seizures, and Conversion Disorder
Miscellaneous/Non-physiological Presentations of DID-Like Symptoms
Conclusion
References
29: Struggle of Family of DID Patients.
Introduction
Attachment Theory Perspective
How Affected Individuals May Perceive the Diagnosis?
How Family May Perceive the Diagnosis?
Challenges Faced by the Family Members
How Support From Family Can Be Beneficial and Impactful?
Conclusion
References
30: DID and Religion: Possession
Introduction
Discussion
Religion, Spirituality, and Their Place in Mental Health
Religion and Dissociative Identity Disorder
Ritual Abuse and Satanic Abuse
Cultural Presentations of Dissociation, Trance Experiences, and Channeling
DID and Possession
Discussion
Conclusion
References
31: Dissociative Identity Disorder and Clinical Trials
Clinical Trials Related to Symptoms
Upcoming or Ongoing Clinical Trials
Clinical Trials Related to Treatment Options
Research Related to Medical Management
Future Direction of DID-Related Research
References
32: Recovery from Dissociative Identity Disorder
Introduction
General Principles
Dealing with Crises (“Nervous Breakdown”)
Coping After Resolution
Layers of Treatment
Clinical Surface
Core Dissociative Dimensions
Functional Dissociation of the Self
Traumatic (Symptomatic) Self
Internal Moderator
Natural Self and Emotions
Dissociated Self-System in Treatment
Touching the Internally Detached Individual
Experiencing Inside or Outside
Undulant Course Versus Intermittent Crises
The Body as a Container of Negative Emotions
Dissociative Depression
Dissociative Psychosis
Mot-a-Mot Thinking (Traumatic Obsessions)
Trauma Types and Interpersonal Boundaries
Working with Alternate Personality States
Intervening in an Emancipatory Way
Prerequisites of Change
Establishing Safety and Security
Dealing with Ongoing Abuse
Appropriate Timing of Trauma Exploration
The Dialectical Dynamic Therapy (DDT)
Theoretical Foundations
The Dialectical Discourse
Four Steps of DDT
The Paradigm Shift
Identificatory Processes
Overcoming the Fear of Loneliness
Ratification of the Acquisitions
Conclusions
References
33: Prognosis of DID
Analysis of Dissociative Identity Disorder through Longitudinal Cohort Studies
Würzburg, Germany Study
Treatment of Patients with Dissociative Disorders Study (TOP DD)
Increased Incidence of Suicidality and Self-Mutilation
Dissociative Identity Disorder and Other Psychiatric Comorbidities
Rate of Recurrence with Pharmacological Monotherapy
Rate of Recurrence with Pharmacological and Psychiatric Combined Therapy
Need for Individualized Treatment Plans
Need for Family Involvement
Group Therapy
Family Therapy
Multi-Modal Approach to Treatment of DID
Predictors of Clinical Course
Adults vs. Children Prognosis
Role of Psychotherapy
Conclusion
References
34: The Impact of DID on a Family’s Life
Introduction
Discussion
Negative Aspects
Emotional Dysregulation
Positive Aspects
Conclusion
References
35: Pharmacological Treatment of Dissociative Identity Disorder
Introduction
The Importance of Treating and Evaluating Comorbid Conditions
Pharmacologic Treatments for DID [7]
Pharmacologic Treatment for Dissociative Disorders
Antipsychotics
Antidepressants
Anxiolytics
Experimental Pharmacological Treatments
Naltrexone
Beta-Blockers and Clonidine
Anticonvulsants
Treatment Outcomes
The Future of Treatment
Conclusion
References
36: Psychotherapy and Non-Pharmacologic Treatment of Dissociative Identity Disorder
Introduction
Treatment Goals and Modalities
Outpatient Treatment
Inpatient Hospitalization
Partial Hospitalization Program
Group Therapy
Specific Considerations
Boundaries
Therapeutic Alliance
Dealing with Alternative Identities
Informed Consent
Theoretical Explanations
Defenses
Dissociation vs. Repression
Dissociation vs. Splitting
The Theory of the Structural Dissociation of the Personality
Common Themes in DID Treatment
Confusion of Roles
Revictimization, Perpetration, and Self-Destructive Behavior
Historical Accuracy of Traumatic Memories
Separateness vs. Wholeness
Phase Oriented Treatment Model
Phase I
Phase II
Phase III
Therapeutic Interventions
Trauma-Focused Psychotherapy
Cognitive Behavioral Therapy
Hypnosis
Eye Movement and Desensitization Reprocessing
Dialectical Behavioral Therapy
Ego State Therapy
Sensorimotor Therapy
Family Therapy
Electroconvulsive Therapy
Conclusion
References
37: Dissociative Identity Disorder and the Law
Introduction
An Overview of the Law as It Applies to Psychiatry
Discussion
Dissociative Identity Disorder and Legal Statues: What the Law Says
Discussion
Discussion
Discussion
Discussion
Link between DID and Crime, Infanticidal Attachment
Discussion
Discussion
Discussion
Dissociation and Its Association with Forensic Aspects of DID
Discussion
Discussion
A Forensic Expert’s Approach to Dissociative Identity Disorder
Discussion
Discussion
Competency and DID
Discussion
Discussion
Dissociative Identity Disorder and Malingering
Discussion
Discussion
Court Cases Involving DID
Conclusion
Conclusion
References
38: Popular Cases of Dissociative Identity Disorder
Introduction
The Three Faces of Eve
Sibyl
Truddi Chase
Herschel Walker
Roseanne
References
39: Dating and DID
Introduction
Interpersonal Relationship Dynamics
Review of Relationship Dynamics
Focus on Romantic Relationship Dynamics
Different Types of Love
Gender Differences in Love
Discussion
Dating in People with Mental Illness
Understanding Interpersonal Relationships in People with Mental Illness
Dating in People with DID
Navigating a Relationship
From the Lens of a Patient with DID
The Significant Other’s Perspective
Advice on Dating Someone with DID
Conclusion
References
40: Dissociative Identity Disorder and Social Media
DID and Social Media
Faking Illnesses Online
Self-Diagnosing Audiences of Social Media Content
Dangerous Algorithms on Social
Self-Expression Outlet for Those with DID
Support and Community Online
Be Mindful of the Content You Consume
Conclusion
References
41: Tips for Dissociative Identity Disorder Patients to Live a Good Life
Introduction
Tips for Dissociative Identity Disorder Patients to Live a Good/Balanced/Healthy Life
Word List Recall
Pharmacotherapy
Procedural Learning
Developing Positive Attitude
Social Support
Shareability Results
Switching
Learning About the Illness
Enrolling in Support Groups
Psychotherapy
Physical Exercises
Balanced Diet
Getting Sufficient Sleep
Meditation
Consistent Physical Movements
Sticking to the Treatment Plans
Determine Priorities
Cognitive-Behavioural Therapy
Tracking Personal Life
Family Support
Career Support
Religious Support
Conclusion
References
42: Tips for Family Members of DID Patients
Introduction
Initial Thoughts on Diagnosis
Importance of Family Support
Initial Support for the Patient’s Safety
What Can You Do and What to Expect?
Role of Listening
Emergent Intervention
Conclusion
References
43: Neuroimaging and DID
Introduction
Trauma-Based Dissociation: Hyperarousal vs. Hypoarousal
Dissociation and Post-traumatic Stress Disorder
Dissociation and Borderline Personality Disorder
Trauma-Based Dissociation and Memory
MRI Studies of Dissociative Identity Disorder
Structural MRI Findings
Functional MRI Findings
PET Studies of Dissociative Identity Disorder
EEG Studies of Dissociative Identity Disorder
Conclusion
References
44: Gender Differences in Dissociative Identity Disorder
Introduction
Female Population and Dissociative Identity Disorder
Male Population and Dissociative Identity Disorder
Transgender Population and Dissociative Identity Disorder
Conclusion
References
45: A Psychiatrist’s Perspective on DID
Introduction
Dissociative Identity Disorder (DID)
DID in Child vs. Adult
Risk Factors
Diagnosis
Treatment
Other Treatment Considerations
Differentials
Conclusion
References
46: Biography and Interview of a Patient with DID
Introduction
Part 1: Biography
Part 2: Interview
Conclusion
47: Comorbid Conditions in Dissociative Identity Disorder Patients: What to Look for?
Introduction
Some Common Comorbid Conditions of DID
Other Psychiatric Disorders
Conclusion
References
48: Dissociative Identity Disorder: The Editor’s Perspective
Introduction
Is Dissociative Identity Disorder Real?
The Impact of Denial
References
Index